J Korean Ophthalmol Soc.  2013 Aug;54(8):1287-1292.

Rapidly Progressing Foveal Atrophy with Tuberculous Serpiginous-Like Choroiditis Despite Combined Anti-Tuberculosis and Steroid Treatment

• Lee JY
• Kang KW
• Shin JP
• Kim IT
• Park DH

Abstract

PURPOSE
To report a case of rapidly progressing foveal atrophy with tuberculous serpiginous-like choroiditis.
CASE SUMMARY
A 54-year-old female patient had decreased vision of hand motions (os) for 3 days. Fundus examination showed optic disc swelling and yellowish chorioretinal lesions in the posterior pole (os). Optical coherence tomography (OCT) showed intraretinal edema and subretinal fluid in the left macula. Routine laboratory tests, serologic tests, and magnetic resonance imaging results were normal except for erythrocyte sedimentation rate (28 mm/hr). Fluorescein angiography showed the chorioretinal lesions appeared to be early hypofluorescence followed by late hyperfluorescence. Indocyanine green angiography showed hypofluorescence during early and late phases and the result of interferon-gamma release assay was positive. Under diagnosis of tuberculous serpiginous-like choroiditis, anti-tuberculous therapy combined with systemic corticosteroid was started. Despite decreased optic disc swelling, OCT showed a rapid progression of foveal atrophy within 2 weeks. Twelve weeks later, visual acuity was finger count at 10 cm. Six months later, best-corrected visual acuity and foveal atrophy were no interval change.
CONCLUSIONS
Tuberculous serpiginous-like choroiditis with foveal involvement can show rapidly progressive foveal atrophy and poor visual prognosis.

Keyword

Anti-tuberculous therapy; Foveal atrophy; Indocyanine green angiography; Interferon-gamma release assay; Tuberculous serpiginous-like choroiditis

MeSH Terms

Angiography
Atrophy
Blood Sedimentation
Choroid
Choroiditis
Edema
Female
Fingers
Fluorescein Angiography
Hand
Humans
Indocyanine Green
Interferon-gamma Release Tests
Magnetic Resonance Imaging
Prognosis
Serologic Tests
Subretinal Fluid
Tomography, Optical Coherence
Vision, Ocular
Visual Acuity
Indocyanine Green

Figure

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  Figure 1. (A) Fundus photograph at the initial visit shows severe optic disc swelling and multiple yellowish chorioretinal lesions. The black arrow indicates optical coherence tomography (OCT) scanning line. (B) OCT shows macular edema and subretinal fluid in the left eye (central subfield thickness: 820 μ m). (C, D) Fluorescence angiography of the left eye. Hypofluorescence in the early phase. (C) hyperfluorescence in the late phase (D) are shown at the initial visit. (E, F) Indocyanine green angiography shows hypofluorescence during the early (E) and late phases (F) at the initial visit.

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  Figure 2. (A) High-resolution chest computerized tomography shows small clustered micronodules in the left lung apex (black arrow). (B) Two weeks later, fundus photograph shows deceased optic disc swelling and diffuse choroiditis with amoeboid pattern in the posterior pole. The black arrow indicates optical coherence tomography (OCT) scanning line. (C) Fluorescence angiography shows hypofluorescence in the lesions and hyperfluorescence in the borders of lesions. (D) OCT shows an irregularly elevated retinal pigment epithelium line and fovea atrophy (central subfield thickness: 169 μ m).

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  Figure 3. (A) Twelve weeks later, fundus photograph shows chorioretinal atrophy with pigmentation in the macula. The black arrow indicates OCT scanning line. (B) Twelve weeks later, OCT shows an irregularly elevated retinal pigment epi-thelium line and fovea atrophy (central subfield thickness: 162 μ m).

Reference

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